泮托拉唑对接受ADP受体阻滞剂治疗的急性ST段抬高型心肌梗死患者治疗期间血小板反应性有影响吗？——一项前瞻性初步研究。

Does Pantoprazole Affect the On-Treatment Platelet Reactivity in Patients With Acute STEMI Treated With ADP Receptor Blockers?-A Pilot Prospective Study.

作者信息

Bolek Tomáš, Samoš Matej, Šimonová Radoslava, Kovář František, Fedor Marián, Galajda Peter, Staško Ján, Kubisz Peter, Mokáň Marián

机构信息

1Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic; and 2National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.

出版信息

Am J Ther. 2017 Mar/Apr;24(2):e162-e166. doi: 10.1097/MJT.0000000000000454.

DOI:10.1097/MJT.0000000000000454

PMID:27415979

Abstract

BACKGROUND

Proton pump inhibition (PPI) administrated together with adenosine diphosphate (ADP) receptor blockers (ADPRB) significantly reduces the risk of gastrointestinal bleeding. Nevertheless, there is a heated discussion about an interaction between PPI and ADPRB that leads to high on-treatment platelet reactivity (HTPR).

STUDY QUESTION

Is there a relationship between pantoprazole PPI and HTPR on ADPRB therapy in patients with acute ST-elevation myocardial infarction (STEMI).

METHODS

Single center pilot study in patients with acute STEMI was performed. This study enrolled totally 87 patients (34 clopidogrel-treated and 53 new ADPRB-treated patients). Pantoprazole was administrated in 33 patients. HTPR was detected with ADP-induced light transmission aggregometry and vasodilator-stimulated phosphoprotein phosphorylation analysis. Samples were taken before coronary angiography (sample 1) and on the next day after the procedure (sample 2).

RESULTS

No significant differences were found in pantoprazole-treated patients and patients without PPI neither in sample 1 (59.2 ± 29.5% vs. 54.9 ± 22.7%, P = 0.49) nor in sample 2 (43.8 ± 27.2% vs. 37.0 ± 22.9%, P = 0.30). Similarly, there were no significant differences in the platelet reactivity index of vasodilator-stimulated phosphoprotein phosphorylation in both samples (sample 1: 53.3 ± 29.8% vs. 65.0 ± 20.5%, P = 0.11; sample 2: 30.8 ± 27.1% vs. 40.6 ± 27.5%, P = 0.19). A comparison of clopidogrel and new ADP receptor blockers in patients on pantoprazole PPI did not reveal significant differences in on-treatment platelet reactivity.

CONCLUSIONS

This study did not reveal interaction between pantoprazole and ADPRB in patients with acute STEMI.

摘要

背景

质子泵抑制剂（PPI）与二磷酸腺苷（ADP）受体阻滞剂（ADPRB）联合使用可显著降低胃肠道出血风险。然而，关于PPI与ADPRB之间相互作用导致治疗期间血小板高反应性（HTPR）的讨论十分激烈。

研究问题

在急性ST段抬高型心肌梗死（STEMI）患者中，泮托拉唑PPI与ADPRB治疗期间的HTPR之间是否存在关联？

方法

对急性STEMI患者进行单中心前瞻性研究。本研究共纳入87例患者（34例接受氯吡格雷治疗，53例接受新型ADPRB治疗）。33例患者使用泮托拉唑。采用ADP诱导的光透射聚集法和血管扩张剂刺激的磷蛋白磷酸化分析检测HTPR。在冠状动脉造影前（样本1）和术后第二天（样本2）采集样本。

结果

泮托拉唑治疗组患者与未使用PPI的患者相比，在样本1中（59.2±29.5%对54.9±22.7%，P = 0.49）和样本2中（43.8±27.2%对37.0±22.9%，P = 0.30）均未发现显著差异。同样，两个样本中血管扩张剂刺激的磷蛋白磷酸化的血小板反应性指数也无显著差异（样本1：53.3±29.8%对65.0±20.5%，P = 0.11；样本2：30.8±27.1%对40.6±27.5%，P = 0.19）。泮托拉唑PPI治疗患者中氯吡格雷与新型ADP受体阻滞剂的治疗期间血小板反应性比较未发现显著差异。